Treatment of incontinence using  collagen similar substances to inject the bladder neck did result in some unsatisfactory results like recurrence and allergy. The use of body similar substances that long last in the region led to much satisfactory results.

Incontinence is the loss of ability to control the bladder function in particular unremarkable loss of urine. This can be due to neurological hyperactivity of the bladder wall or more common the weakness of the mechanism of closure of the bladder.

The reason why some men suffer under this agonising social problem after the radical prostatectomy is the injury of the muscles of the pelvic floor and the injury to the bladder sphincter.

The incontinence has three different grades:

1. the patient loses urine under  massive activity,
2. the patient loses urine under some body activity like walking fast or sneezing and coughing
3. patients are wetting themselves under light activity like normally walking or even standing from the sitting  position or even continuously.

This is the so called stress incontinence which may be combined with the more agonising urge incontinence. The stress incontinence can be treated in this case by the implantation of scott sphincter.

Recently it is possible to treat the different grades of incontinence through the injection of a collagen in the bladder neck area to increase the resistance of this region when it is exposed to a high pressure thus preventing the leakage of urine. This goes right in particular in previously operated patients.

The urge incontinence is a sort of hypersensitivity to the normal sensation of the bladder or a hyperactivity of the muscle of the bladder itself. This later cause of incontinence can be treated medically.   
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Anatomy of a man
Please note the relationship between
Bladder, prostate, peritoneum and rectum.
B = bladder / P = Prostate
Sv = seminal vesicle / Pn = penis
U = urethra / T = testis

During the pressure measurements are recorded the different values of bladder, stomach, urethra and muscles of the pelvic floor.
Pves = pressure in the bladder
Pabd = pressure in the abdomen
Pdet = pressure of the muscles of the bladder
Qura = pressure in the urethra
= EMG activity of the muscles of the pelvic floor

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Who qualifies for the operation ?

Patients suffering from stress incontinence  after the radical prostatectomy. The operation should be done after excluding or treating the urge component. It is advised to reduce weight before the operation and to use some physical aids to increase the effect of the operation that may have to be repeated for 3-4 times before a satisfactory effect is reached.

How does the operation work ?

The patient lies in the lithotomy position on the back. The urethra and bladder should be inspected endosmotically. the urethral tract should be anaesthetised under endoscopic or sonographic control.

The collagen is brought to the bladder neck in front of the Colliculus Seminalis through a special needle piercing the Para urethral tissues till the bladder neck. the injection follows under endoscopic video control in 3 or 4 places in the bladder neck to create a narrower tract in the region. The needle is withdrawn and the patient is put under observation for 1-2 hours before dismiss ion.

Healing:

The patients are treated on out patient basis and are dismissed after being sure that the urine is clear and pain is alleviated. Patients has to avoid strong activity for some days post operatively.

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1. Does incontinence happen to every one had the radical prostatectomy done on him?
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   No, this depends on how far was the excision of the tissues during the operation which is dependant on the stage of the disease.
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2. Can one diagnose the permanent continuous incontinence immediately after the operation?
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   The patient is in most cases intermittently incontinent. The final evaluation is done after a period of physical training and electro stimulation of 6 months. However if I observe that the patient is loosing urine and is not able even to strangulate the stream or that the incontinence is permanent, then the operation is indicated after 6 months of the radical prostatectomy.
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3. Is the operation a one stage procedure?
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   No, sometimes it is necessary to repeat the injection.
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4. Does collagen provoke allergic reactions?
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   There is  no allergic reaction observed till now of the injected collagen. Patients with a past history of allergic reactions are not injected with collagen.
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5. Does it obstruct the urethra?
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   No. There may be a sort of bladder neck obstruction sometimes. This may necessitate the incision of the bladder neck in very few cases.